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Communicating Risk

Many of the questions I get on my Facebook page relate to decision making. Should I proceed with thyroidectomy? Should I try radioactive iodine for my hyperthyroidism as my doctor suggests? What will happen if I don’t have a biopsy done?

Last May, I had translated into Filipino, these 4 questions to ask the doctor from Choosing Wisely Canada.


Ahmed H et. al (Communicating Risk. BMJ 2012;344:e3996) says –

Communicating risk involves providing the patient with a balanced evidence based summary of the risks and harms associated with a service, test or treatment.

Communicating risk is very important as the physician depending on how he frames the options can, I believe, sway the patient towards one option or the other. Or he can paralyze the patient with fear, leading to possible harmful inaction. Last year, I wrote a post about communicating risk to patients Whose Choice Is It Anyway? on deciding which medicines to take for diabetes.

Let’s discuss risk communication at the #HealthXPH tweet chat on July 2, 9 pm Manila time (9 am EST).

John Paling in Strategies to Help Patients Understand Risks (BMJ. 2003 Sep 27; 327(7417): 745–748) emphasizes the importance of risk communication –

Explaining risks to patients in an effective way is an essential part of ensuring that consent is “informed.”

T1. How should physicians communicate risk to patients?

Fagerlin A et al. (Helping Patients Decide: Ten Steps to Better Risk Communication. JNCI J Natl Cancer Inst (2011) doi: 10.1093/jnci/djr318)  says patients may not “understand the words that their doctors use when describing medical alternatives.”

T2. What are the barriers to effective risk communication?

What do patients prefer? Fortin JM et al. (Identifying patient preferences for communicating risk estimates: a descriptive pilot study. BMC Medical Informatics and Decision Making 2001 DOI: 10.1186/1472-6947-1-2) did a study where perimenopausal women were presented with risk data in various formats, for them to decide on hormone replacement therapy. They concluded –

Although there are many different formats for presenting and framing risk information, simple bar charts depicting absolute lifetime risk were rated and ranked highest overall for patient preferences for format.

T3. How effective are decision aids?

Join the discussion at #HealthXPH and let us know what you think.

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